期刊
BMC INFECTIOUS DISEASES
卷 21, 期 1, 页码 -出版社
BMC
DOI: 10.1186/s12879-021-05904-3
关键词
Streptococcus pneumoniae; Staphylococcus aureus; Moraxella catarrhalis; Haemophilus influenzae; Antibiotic resistance; Children; HIV; Chronic lung disease
资金
- Global Health and Vaccination Research (GLOBVAC) Programme of the Medical Research Council of Norway
- Swedish International Development Cooperation Agency (SIDA) through Organisation of Women in Science for the developing world (OWSD) PhD Fellowship
- Margaret McNamara Education Grants
- L'Oreal UNESCO For Women in Science Fellowship
- Australian National Health and Medical Research Council Investigator Grant [APP1174455]
- UK Medical Research Council (MRC)
- UK Department for International Development (DFID)
- European Union [MR/R010161/1]
- Wellcome Trust
- National Research Foundation of South Africa [112160]
- Leaders -African Independent Research (FLAIR) Fellowship
- National Institute for Health Research (NIHR) Global Health Research Unit on Mucosal Pathogens
- University of Cape Town
- Allergy Society of South Africa (ALLSA)
- UK aid from the UK Government
- MRC [MR/R010161/1] Funding Source: UKRI
HIV-associated chronic lung disease (CLD) is common among children living with HIV (CLWH) in sub-Saharan Africa. CLD+ CLWH are more likely to be colonised by MC and SP strains, including penicillin-non-susceptible SP strains, than CLD- CLWH. The role of these bacteria in CLD pathogenesis, including the risk of acute exacerbations, should be further studied.
BackgroundHIV-associated chronic lung disease (CLD) is common among children living with HIV (CLWH) in sub-Saharan Africa, including those on antiretroviral therapy (ART). However, the pathogenesis of CLD and its possible association with microbial determinants remain poorly understood. We investigated the prevalence, and antibiotic susceptibility of Streptococcus pneumoniae (SP), Staphylococcus aureus (SA), Haemophilus influenzae (HI), and Moraxella catarrhalis (MC) among CLWH (established on ART) who had CLD (CLD+), or not (CLD-) in Zimbabwe and Malawi.MethodsNasopharyngeal swabs (NP) and sputa were collected from CLD+ CLWH (defined as forced-expiratory volume per second z-score<-1 without reversibility post-bronchodilation with salbutamol), at enrolment as part of a randomised, placebo-controlled trial of azithromycin (BREATHE trial - NCT02426112), and from age- and sex-matched CLD- CLWH. Samples were cultured, and antibiotic susceptibility testing was conducted using disk diffusion. Risk factors for bacterial carriage were identified using questionnaires and analysed using multivariate logistic regression.ResultsA total of 410 participants (336 CLD+, 74 CLD-) were enrolled (median age, 15years [IQR=13-18]). SP and MC carriage in NP were higher in CLD+ than in CLD- children: 46% (154/336) vs. 26% (19/74), p=0.008; and 14% (49/336) vs. 3% (2/74), p=0.012, respectively. SP isolates from the NP of CLD+ children were more likely to be non-susceptible to penicillin than those from CLD- children (36% [53/144] vs 11% [2/18], p=0.036). Methicillin-resistant SA was uncommon [4% (7/195)]. In multivariate analysis, key factors associated with NP bacterial carriage included having CLD (SP: adjusted odds ratio (aOR) 2 [95% CI 1.1-3.9]), younger age (SP: aOR 3.2 [1.8-5.8]), viral load suppression (SP: aOR 0.6 [0.4-1.0], SA: 0.5 [0.3-0.9]), stunting (SP: aOR 1.6 [1.1-2.6]) and male sex (SA: aOR 1.7 [1.0-2.9]). Sputum bacterial carriage was similar in both groups (50%) and was associated with Zimbabwean site (SP: aOR 3.1 [1.4-7.3], SA: 2.1 [1.1-4.2]), being on ART for a longer period (SP: aOR 0.3 [0.1-0.8]), and hot compared to rainy season (SP: aOR 2.3 [1.2-4.4]).ConclusionsCLD+ CLWH were more likely to be colonised by MC and SP, including penicillin-non-susceptible SP strains, than CLD- CLWH. The role of these bacteria in CLD pathogenesis, including the risk of acute exacerbations, should be further studied.
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